Holiday Inductions: You Have Options
So since we’re entering the holiday season, I wanted to write a little something regarding inductions and some of your options.
The holiday season, has the highest rate of inductions that are NOT medically necessary. Why you might ask? Because most doctors feel it’s more convenient for them. They want you to have your baby so they can get paid (because they only get paid for the delivery when they catch your baby) and so they can also time it and make sure that they are with their family instead of at your birth for the holiday. So nice of them right?
***Anything with a line beneath it is a clickable link that has more information 😊
Induction options:
ACOG’s FAQ’s Regarding Induction
Membrane Sweeping/Stripping: This is when a vaginal exam is performed to see if your cervix has begun changing or not. Your care provider can then “strip your membranes” by placing a gloved finger into your cervix (whether or not it’s open) and sweeping around in a circular motion to try and “irritate” the cervix into releasing hormones to kick start labor. Can be extremely painful if cervix is not favorable, however many people say that it is not painful at all (these people are typically 3+ cm dilated when being swept). This is a non pharmaceutical option that has a fairly high rate of success IF you are already teetering on the edge of labor.
Foley Bulb/Balloon: (FDA Insert) it is a type of catheter that was repurposed for labor induction and is inserted into the cervix (which means your cervix needs to be open enough to insert it) and then filled with saline solution to expand. The bulb of the catheter (portion that is filled) then puts pressure on your cervix from inside the uterus to hopefully soften it and open it. The foley bulb typically falls about when the cervix is dilated to about 4 cm. This is a non pharmaceutical option that costs the hospital a bit more money than other options because it is typically more gentle by being slower acting.
Cooks Catheter: (FDA Pre-Summary) This is similar to the Foley Bulb, however the Cook’s catheter has two bulbs that put pressure on the cervix simultaneously, to mechanically soften and open it; there is a bulb on either side of the cervix, one is inside the uterus and the other one is in the vaginal canal. This is a non pharmaceutical option that costs the hospital a bit more money than other options because it is typically more gentle by being slower acting. Many hospitals do not have this in stock so it may not be an option depending on what hospital you are birthing at.
Cervidil: (FDA Insert) This a prostaglandin gel (contraindicated for VBAC/TOLAC’s) that is placed on an insert that is then placed directly next to the cervix and left there for 12 hours. It is then replaced every 12 hours to ripen and soften the cervix. This is a pharmaceutical option that costs the hospital a bit more money than other options because it is typically more gentle by being slower acting.
Cytotec (Misoprostal): (Please see the FDA insert for this drug: Cytotec - Misoprostal Tablets) It is a tablet that is inserted into the vagina (most commonly) but can also be given by mouth every 4 hours until either the cervix has become more favorable or has dilated to whatever they deem is necessary to begin the next phase/stage of the induction process if a labor pattern has not been achieved. You will be hooked up to the monitors continuously so that they can watch baby and your contractions. Once given, Cytotec cannot be reversed. If pill was placed vaginally a vaginal flush with saline may help. If something happens because of the cytotec, it is typically an emergency cesarean section to make sure both you and the baby are ok, meaning you will be put under general anesthesia if an epidural/spinal block hasn’t already been placed. This is a pharmaceutical option that is cheap for the hospital to use (and is typically their first course of action).
~ Link to a video by Ina May Gaskin on the History of Cytotec (warning can be triggering for some).
Pitocin: (FDA Insert) This is the synthetic form of oxytocin and while chemically it is the exact same as the form of Oxytocin we produce in our bodies, it is delivered to our bodies drastically different. Our bodies secrete Oxytocin in labor in pulses, while Pitocin is given continuously intravenously (through an IV). Because it is a continuous delivery, it produces longer and stronger contractions. If it is too much for baby (which they can see on the monitor) they will turn down the dosage. Many people who have an induction but wanted to deliver unmedicated will choose an epidural because of the contractions that Pitocin produces. This is a pharmaceutical option and you will be required to be monitored continuously so that they can keep an eye on your contractions and baby. This is a pharmaceutical option that is cheap for the hospital to use and one of the initial pharmaceuticals they will use if your cervix has already begun dilating.
Artificial Rupture of Membranes (AROM): There is no medical reason for your bags of waters to be broken. However, it CAN (not always) help labor progress by bringing baby down closer to your cervix and placing more pressure on it to help open it. This will place you on the hospital clock of 24 hours to birth your baby (some hospitals are ok with 36-48 hours depending on the hospital and how birthing person and baby are looking and whether or not a fever spikes).
Is my induction medically necessary?
A lot of non-medically necessary inductions happen during the holidays. Many care providers will likely say for example “you’ll be 39 weeks and 3 days on the 20th of December, let’s just schedule your induction for that day, how does that sound? You’ll be home with your new baby by Christmas!”
And as awesome as that may sound, sometimes due dates can be off. Here is a link to the Evidence Based Birth article regarding due dates: Evidence On: Due Dates.
ACOG’s guidelines for pregnancy length is 37 weeks to 42 weeks:
37 weeks 0 days and 38 weeks 6 days is “early term”
39 weeks 0 days and 40 weeks 6 days is “full term”
41 weeks 0 days and 41 weeks 6 days is “late term”
42 weeks and 0 days or later is “post term”
However you can do a few things:
Ask “Am I ok? Is my baby ok?” If both of the answers to those questions are yes, do you think your induction would be medically necessary?
Ask “What medical reason is the induction for?” if they give you a no to either of the previous questions. Many care providers will try and use scare tactics to persuade/coerce their patient into an induction even if it’s not medically necessary.
Educate yourself on your options. Like if they schedule an induction for you and it’s not medically necessary, are you going to show up? Are you going to reschedule it? What are you going to say to your doctor?
Remember the BRAIN acronym:
B - Benefits: What is the benefit of this procedure?
R - Risks: What are the risks of this procedure?
A - Alternative: Are there any alternatives that we can do?
I - Intuition: What is your intuition telling you?
N - Nothing: What if we do nothing?You can always ask for more time to talk and think things over. If it’s a true emergency, you won’t get any time to do anything. True emergencies (are rare) but it’s people running all over the place, typically yelling, and pushing you down the hall to an OR, there’s no talking.
Beautiful inductions CAN happen and do happen (I’ve seen a handful). However, being educated on your options provides you with confidence to ask whether or not the induction they’re suggesting is medically necessary. The birth of your baby, is the first time you really step into the serious parental shoes and begin making real life decisions for you and your baby. You can do it, and you can totally enjoy the holiday season as well (still pregnant or not 😉)!!